1
|
O’Shaughnessy Í, Robinson K, Whiston A, Barry L, Corey G, Devlin C, Hartigan D, Synnott A, McCarthy A, Moriarty E, Jones B, Carroll I, Shchetkovsky D, O’Connor M, Steed F, Carey L, Conneely M, Leahy A, Quinn C, Shanahan E, Ryan D, Galvin R. Comprehensive Geriatric Assessment in the Emergency Department: A Prospective Cohort Study of Process, Clinical, and Patient-Reported Outcomes. Clin Interv Aging 2024; 19:189-201. [PMID: 38343726 PMCID: PMC10859053 DOI: 10.2147/cia.s434641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/01/2023] [Indexed: 02/15/2024] Open
Abstract
Background This study aimed to explore the process, clinical, and patient-reported outcomes of older adults who received an interdisciplinary Comprehensive Geriatric Assessment (CGA) in the emergency department (ED) over a six-month period after their initial ED attendance. Patients and Methods A prospective cohort study recruited older adults aged ≥65 years who presented to the ED of a university teaching hospital in Ireland. Baseline assessment data comprising a battery of demographic variables and validated indices were obtained at the index ED attendance. Telephone interviews were completed with participants at 30- and 180-day follow-up. The primary outcome was incidence of hospital admission following the index ED attendance. Secondary outcomes included participant satisfaction, incidence of functional decline, health-related quality of life, incidence of unscheduled ED re-attendance(s), hospital (re)admission(s), nursing home admission, and death. Results A total of 133 participants (mean age 82.43 years, standard deviation = 6.89 years; 71.4% female) were recruited; 21.8% of the cohort were admitted to hospital following the index ED attendance with a significant decline in function reported at hospital discharge (Z = 2.97, p = 0.003). Incidence of 30- and 180-day unscheduled ED re-attendance was 10.5% and 24.8%, respectively. The outcome at the index ED attendance was a significant predictor of adverse outcomes whereby those who were discharged home had significantly lower odds of multiple adverse process outcomes at 30- and 180-day follow-up, and significantly higher function and health-related quality of life at 30-day follow-up. Conclusion While this study was observational in nature, findings suggest CGA in the ED may improve outcomes by mitigating against the adverse effects of potentially avoidable hospital admissions and focusing on a longitudinal approach to healthcare delivery at the primary-secondary care interface. Future research should be underpinned by an experimental study design to address key limitations in this study.
Collapse
Affiliation(s)
- Íde O’Shaughnessy
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aoife Whiston
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Louise Barry
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Gillian Corey
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Collette Devlin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Deirdre Hartigan
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aoife Synnott
- Department of Physiotherapy, University Hospital Limerick, Limerick, Ireland
| | - Aoife McCarthy
- Department of Occupational Therapy, University Hospital Limerick, Limerick, Ireland
| | - Eoin Moriarty
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Bryan Jones
- Department of Medical Social Work, University Hospital Limerick, Limerick, Ireland
| | - Ida Carroll
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Denys Shchetkovsky
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland
| | - Margaret O’Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
- School of Medicine, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Fiona Steed
- Department of Health, Government of Ireland, Dublin, Ireland
| | - Leonora Carey
- Department of Occupational Therapy, University Hospital Limerick, Limerick, Ireland
| | - Mairéad Conneely
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aoife Leahy
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Colin Quinn
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Elaine Shanahan
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Damien Ryan
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland
- School of Medicine, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| |
Collapse
|
2
|
Mount RA, Athif M, O’Connor M, Saligrama A, Tseng HA, Sridhar S, Zhou C, Bortz E, San Antonio E, Kramer MA, Man HY, Han X. The autism spectrum disorder risk gene NEXMIF over-synchronizes hippocampal CA1 network and alters neuronal coding. Front Neurosci 2023; 17:1277501. [PMID: 37965217 PMCID: PMC10641898 DOI: 10.3389/fnins.2023.1277501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/10/2023] [Indexed: 11/16/2023] Open
Abstract
Mutations in autism spectrum disorder (ASD) risk genes disrupt neural network dynamics that ultimately lead to abnormal behavior. To understand how ASD-risk genes influence neural circuit computation during behavior, we analyzed the hippocampal network by performing large-scale cellular calcium imaging from hundreds of individual CA1 neurons simultaneously in transgenic mice with total knockout of the X-linked ASD-risk gene NEXMIF (neurite extension and migration factor). As NEXMIF knockout in mice led to profound learning and memory deficits, we examined the CA1 network during voluntary locomotion, a fundamental component of spatial memory. We found that NEXMIF knockout does not alter the overall excitability of individual neurons but exaggerates movement-related neuronal responses. To quantify network functional connectivity changes, we applied closeness centrality analysis from graph theory to our large-scale calcium imaging datasets, in addition to using the conventional pairwise correlation analysis. Closeness centrality analysis considers both the number of connections and the connection strength between neurons within a network. We found that in wild-type mice the CA1 network desynchronizes during locomotion, consistent with increased network information coding during active behavior. Upon NEXMIF knockout, CA1 network is over-synchronized regardless of behavioral state and fails to desynchronize during locomotion, highlighting how perturbations in ASD-implicated genes create abnormal network synchronization that could contribute to ASD-related behaviors.
Collapse
Affiliation(s)
- Rebecca A. Mount
- Department of Biomedical Engineering, Boston University, Boston, MA, United States
| | - Mohamed Athif
- Department of Biomedical Engineering, Boston University, Boston, MA, United States
| | | | - Amith Saligrama
- Department of Biomedical Engineering, Boston University, Boston, MA, United States
- Commonwealth School, Boston, MA, United States
| | - Hua-an Tseng
- Department of Biomedical Engineering, Boston University, Boston, MA, United States
| | - Sudiksha Sridhar
- Department of Biomedical Engineering, Boston University, Boston, MA, United States
| | - Chengqian Zhou
- Department of Biomedical Engineering, Boston University, Boston, MA, United States
| | - Emma Bortz
- Department of Biomedical Engineering, Boston University, Boston, MA, United States
| | - Erynne San Antonio
- Department of Biomedical Engineering, Boston University, Boston, MA, United States
| | - Mark A. Kramer
- Department of Mathematics, Boston University, Boston, MA, United States
| | - Heng-Ye Man
- Department of Biology, Boston University, Boston, MA, United States
| | - Xue Han
- Department of Biomedical Engineering, Boston University, Boston, MA, United States
| |
Collapse
|
3
|
Conneely M, Leahy S, O’Connor M, Corey G, Gabr A, Saleh A, Okpaje B, O’ Shaughnessy Í, Synnott A, McCarthy A, Holmes A, Robinson K, Ryan L, Griffin A, Barry L, Trépel D, Ryan D, Galvin R. A Physiotherapy-Led Transition to Home Intervention for Older Adults Following Emergency Department Discharge: A Pilot Feasibility Randomised Controlled Trial (ED PLUS). Clin Interv Aging 2023; 18:1769-1788. [PMID: 37901478 PMCID: PMC10612516 DOI: 10.2147/cia.s413961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/11/2023] [Indexed: 10/31/2023] Open
Abstract
Background Older adults frequently attend the emergency department (ED) and experience high rates of subsequent adverse outcomes including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. Our aim was to evaluate the feasibility of a physiotherapy-led integrated care intervention for older adults discharged from the ED (ED PLUS). Patients and Methods Older adults presenting to the ED of a university teaching hospital with undifferentiated medical complaints and discharged within 72 hours were computer randomised in a ratio of 1:1:1 to deliver usual care, Comprehensive Geriatric Assessment (CGA) in the ED, or ED PLUS. ED PLUS is an evidence-based and stakeholder-informed intervention to bridge the care transition between the ED and community by initiating a CGA in the ED and implementing a six-week, multi-component, self-management programme in the patient's home. Feasibility and acceptability were assessed quantitatively and qualitatively. All clinical and process outcomes were assessed by a research nurse blinded to group allocation. Data analyses were primarily descriptive. Results Twenty-nine participants were recruited indicating a 67% recruitment rate. At 6 months, there was 100% retention in the usual care group, 88% in the CGA group and 90% in the ED PLUS group. ED PLUS participants expressed positive feedback, and there was a trend towards improved function and quality of life and less ED revisits and unscheduled hospitalisations in the ED PLUS group. Conclusion ED PLUS bridges the transition of care between the index visit to the ED and the community and is feasible using systematic recruitment strategies. Despite recruitment challenges in the context of COVID-19, the intervention was successfully delivered and well received by participants. There was a lower incidence of functional decline and improved quality of life in the ED PLUS group. Trial Registration The trial was registered in Clinical Trials Protocols and Results System as of 21st July 2021, with registration number NCT04983602.
Collapse
Affiliation(s)
- Mairéad Conneely
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Siobhán Leahy
- Department of Sport, Exercise & Nutrition, School of Science & Computing, Atlantic Technological University, Galway, Ireland
| | - Margaret O’Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Gillian Corey
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Ahmed Gabr
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Anastasia Saleh
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Blessing Okpaje
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Íde O’ Shaughnessy
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Aoife Synnott
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Aoife McCarthy
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Alison Holmes
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Lorna Ryan
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anne Griffin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Louise Barry
- School of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Dominic Trépel
- Trinity Institute of Neurosciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Damian Ryan
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - On behalf of Ageing Research Centre Public and Patient Involvement (PPI) Panel of older adults
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Sport, Exercise & Nutrition, School of Science & Computing, Atlantic Technological University, Galway, Ireland
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
- School of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Trinity Institute of Neurosciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland
| |
Collapse
|
4
|
Aregay A, O’Connor M, Stow J, Ayers N, Lee S. Perceived policy-related barriers to palliative care implementation: a qualitative descriptive study. Palliat Care Soc Pract 2023; 17:26323524231198542. [PMID: 37706166 PMCID: PMC10496462 DOI: 10.1177/26323524231198542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023] Open
Abstract
Background Ethiopia has a national palliative care guideline, and palliative care is explicitly recognised in the country's healthcare policy and health sector transformation plans. However, palliative care is not fully delivered in the regional public hospitals and primary health care units. Objective This study explores perceived policy barriers to deliver palliative care services in rural and regional healthcare settings, which primary healthcare units largely serve. Design Face-to-face interviews were conducted in a rural region of Ethiopia. Methods Forty-two participants were recruited from a variety of health settings including primary, secondary and tertiary levels across the region. Interviews were conducted with policymakers from the regional health bureau, pharmacists, medical doctors, health officers (clinical officers) and nurses, including chief nursing officers in leadership roles at all levels of healthcare institutions. Data analysed using thematic analysis. Results Participants described several barriers related to healthcare policy, including lack of government priority and focus on palliative care; lack of health professionals' awareness of the national palliative care plans and guidelines; and lack of palliative care integration into the existing healthcare system and the national budget. Participants remarked that palliative care services in the region were mainly limited to HIV patients, often managed with external support and, hence unsustainable. Conclusions Policy priority and focus is a fundamental component for the provision of palliative care because lack of focus and support from the government have led to inadequate access to palliative care for all in need. Hence, as participants suggested, palliative care should be integrated into all healthcare levels, particularly into the primary health care units and the health extension programme, to facilitate health extension workers to support millions living in rural areas.
Collapse
Affiliation(s)
- Atsede Aregay
- Health and Nursing Sciences, University of Agder, Høvågveien 140, Kristiansand, 4604, Norway
- School of Nursing, Mekelle University, Tigray, Ethiopia
| | - Margaret O’Connor
- Nursing and Midwifery, Monash University, Melbourne City Mission Palliative Care, Melbourne, Australia
| | - Jill Stow
- St Vincent’s Private Hospital, Melbourne, Australia
| | - Nicola Ayers
- Nurse Lecturer, School of Nursing, BPP University, London, UK
| | - Susan Lee
- Nursing and Midwifery, Monash University, Melbourne, Australia
| |
Collapse
|
5
|
O’Connor M, Stapleton A, O'Reilly G, Murphy E, Connaughton L, Hoctor E, McHugh L. The efficacy of mindfulness-based interventions in promoting resilience: A systematic review and meta-analysis of randomised controlled trials. Journal of Contextual Behavioral Science 2023. [DOI: 10.1016/j.jcbs.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
|
6
|
Williams S, O’Riordan C, Steed F, Leahy A, Shanahan E, Peters C, O’Connor M, Galvin R, Morrissey AM. Early Supported Discharge for Older Adults Admitted to Hospital with Medical Complaints: A Qualitative Study Exploring the Views of Stakeholders. J Multidiscip Healthc 2022; 15:2861-2870. [PMID: 36561433 PMCID: PMC9766477 DOI: 10.2147/jmdh.s380572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/07/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Early supported discharge (ESD) is well established as a model of health service delivery for people with stroke. Emerging evidence indicates that ESD also reduces the length of stay for older medical inpatients. There is a dearth of evidence exploring the views of stakeholders on ESD as a model of care for older medical inpatients. The overall aim of this study is to explore the views and perceptions of older adults, family carers and healthcare professionals on the potential role of ESD for older adults admitted to hospital with medical complaints. Methods Purposeful sampling was used to recruit older adults and family carers for interview. For Healthcare Professionals (HCPs), snowball purposeful sampling was used. Phone interviews took place following a semi-structured interview guide. Focus groups were moderated by A-MM. Braun and Clarke's approach to thematic analysis was used. Ethical approval was granted by the HSE Mid-Western Area Regional Ethics Committee in November 2021 (REC Ref. 096/2021). Results Fifteen HCPs took part across three focus groups, with six older adults and two family members participating in one-to-one interviews. Three themes were identified: 1. Pre-ESD experiences of providing and receiving older adult inpatient care, 2. Navigating discharge procedures from acute hospital services, 3. A vision for more integrated model of care and a medical ESD team. Discussion This study provided insight into the current discharge experiences of older adult care in the acute setting, the potential role for ESD in this population and the key factors that would need to be considered for the running of an ESD service for older adults admitted to hospital with medical complaints. Conclusion This research highlights the barriers and facilitators to ESD for older medical inpatients from the perspectives of key stakeholders. Given the adverse outcomes associated with prolonged hospital stay, these findings will help inform the development of a feasibility trial, examining patient and process outcomes for older adults admitted to hospital with medical complaints who receive an ESD intervention.
Collapse
Affiliation(s)
- Susan Williams
- School of Allied Health, University of Limerick, Limerick, Ireland,Correspondence: Susan Williams, School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland, Email
| | - Clíona O’Riordan
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Fiona Steed
- Department of Medicine, University Hospital Limerick, Limerick, Ireland
| | - Aoife Leahy
- School of Allied Health, University of Limerick, Limerick, Ireland,Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Elaine Shanahan
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Catherine Peters
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Margaret O’Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland,School of Medicine, University of Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, University of Limerick, Limerick, Ireland
| | | |
Collapse
|
7
|
Walsh D, Hamid M, Hannan M, Tabb E, Dunne E, Horgan A, Lynch P, MyoOo N, O’Connor M, Calvert P, Jordan E. Impact of Cancer Treatment on Polypharmacy Status and Subsequent Hospitalisation due to Toxicity in Older Adults with Cancer. J Geriatr Oncol 2022. [DOI: 10.1016/s1879-4068(22)00390-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
8
|
Lucas M, Merchant M, O’Connor M, Smith S, Trombino A, Waters N, Eathiraj S, Buck E. BDTX-1535, a fourth generation EGFR inhibitor, targeting intrinsic and acquired resistance mutations in NSCLC. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00862-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
9
|
Veronese N, Custodero C, Demurtas J, Smith L, Barbagallo M, Maggi S, Cella A, Vanacore N, Aprile PL, Ferrucci L, Pilotto A, Alberto P, Maria Cristina P, Alves M, Benzinger P, Berg N, Brach J, Cardoso I, Cella A, Chefi B, Ciurea A, Cornejo Lingan Ana M, Cotobal Rodeles S, Cruz-Jentoft A, Curiale V, Custodero C, Danielova L, Davies F, De Groot A, De Groot C, De Lepeleire J, De Vries B, Decock AM, Denkinger M, Dikmeer A, Dini S, Durand A, Fatin A, Fernandes M, Ferrara N, Francis B, Fratiglioni L, Freiberger E, Galvin R, Garmendia B, Gillain S, Gomez Pavon J, Goudzwaard J, Greco A, Gruner H, Gunther B, Happe L, Hermush V, Huibregtse Bimmel JK, Indiano I, Isaak J, Jaramillo J, Kerminen H, Laocha Aoife N, Lau S, Lozano I, Madeira Sarmento Ana T, Mangoni A, Marques da Silva P, Mars P, Matejovska-Kubesova H, Mattace Raso F, Moeskops S, Molnar A, Musacchio C, Nagaratnam K, Nieminen U, O’Connor M, Özge Kayhan Koçak F, Paccalin M, Palikhe A, Pavic T, Per Nordnes R, Platon I, Polinder H, Prada G, Ragnheim R, Ramsawak L, Rewiuk K, Rodrigues C, Roller-Wirnsberger R, Rossinen J, Ruotolo G, Ruppe G, Ryan D, Sabba C, Sanchez E, Savas S, Schmid V, Schroderus K, Siegrist M, Smedberg D, Smit O, Soulis G, Tampaki M, Tenkattelaar N, Thiem U, Topinkova E, Tromp J, Van Beek M, Van Heijningen L, Vandeelen B, Vanderhulst H, Vankova H, Verissimo R, Vonk M, Vrabie C, Wearing P, Weiss M, Welmer AK, Werle B, Ylmaz O, Shoaib Muhammad Z, Zamfir M, Zanom I, Zuidhof J, Nicola V, Lee S, Alves M, Avcy S, Bahat-Ozturk G, Balci C, Beaudart C, Bruyère O, Cherubini A, Da Cruz Alves M, Firth J, Goisser S, Hursitoglu M, Hurst C, Kemmler W, Kiesswetter E, Kotsani M, Koyanagi A, Locquet M, Marengoni A, Nida M, Obretin Florian A, O’Hanlon S, Okpe A, Pedone C, Petrovic M, Pizzol D, Prokopidis K, Rempe H, Sanchez Rodrigues D, Schoene D, Schwingshackl L, Shenkin S, Solmi M, Soysal P, Stubbs B, Thompson T, Torbahn G, Unim B. Comprehensive geriatric assessment in older people: an umbrella review of health outcomes. Age Ageing 2022; 51:6581610. [PMID: 35524746 DOI: 10.1093/ageing/afac104] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Comprehensive geriatric assessment (CGA) has been in use for the last three decades. However, some doubts remain regarding its clinical use. Therefore, we aimed to capture the breadth of outcomes reported and assess the strength of evidence of the use of comprehensive geriatric assessment (CGA) for health outcomes in older persons. METHODS Umbrella review of systematic reviews of the use of CGA in older adults searching in Pubmed, Embase, Scopus, Cochrane library and CINHAL until 05 November 2021. All possible health outcomes were eligible. Two independent reviewers extracted key data. The grading of evidence was carried out using the GRADE for intervention studies, whilst data regarding systematic reviews were reported as narrative findings. RESULTS Among 1,683 papers, 31 systematic reviews (19 with meta-analysis) were considered, including 279,744 subjects. Overall, 13/53 outcomes were statistically significant (P < 0.05). There was high certainty of evidence that CGA reduces nursing home admission (risk ratio [RR] = 0.86; 95% confidence interval [CI]: 0.75-0.89), risk of falls (RR = 0.51; 95%CI: 0.29-0.89), and pressure sores (RR = 0.46; 95%CI: 0.24-0.89) in hospital medical setting; decreases the risk of delirium (OR = 0.71; 95%CI: 0.54-0.92) in hip fracture; decreases the risk of physical frailty in community-dwelling older adults (RR = 0.77; 95%CI: 0.64-0.93). Systematic reviews without meta-analysis indicate that CGA improves clinical outcomes in oncology, haematology, and in emergency department. CONCLUSIONS CGA seems to be beneficial in the hospital medical setting for multiple health outcomes, with a high certainty of evidence. The evidence of benefits is less strong for the use of CGA in other settings.
Collapse
Affiliation(s)
- Nicola Veronese
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Jacopo Demurtas
- Clinical and Experimental Medicine PhD Program, Università di Modena e Reggio Emilia, Modena, Italy
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Mario Barbagallo
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Stefania Maggi
- Institute of Neuroscience, Aging Branch, CNR, Padua, Italy
| | - Alberto Cella
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy
| | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | | | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, National Institute of Health, MD, USA
| | - Alberto Pilotto
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
O’Shaughnessy Í, Robinson K, O’Connor M, Conneely M, Ryan D, Steed F, Carey L, Leahy A, Shanahan E, Quinn C, Galvin R. Effectiveness of acute geriatric unit care on functional decline, clinical and process outcomes among hospitalised older adults with acute medical complaints: a systematic review and meta-analysis. Age Ageing 2022; 51:6575883. [PMID: 35486670 PMCID: PMC9053463 DOI: 10.1093/ageing/afac081] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Indexed: 12/21/2022] Open
Abstract
Background the aim of this systematic review and meta-analysis was to update and synthesise the totality of research evidence on the effectiveness of acute geriatric unit (AGU) care for older adults admitted to hospital with acute medical complaints. Methods MEDLINE, CINAHL, CENTRAL and Embase databases were systematically searched from 2008 to February 2022. Screening, data extraction and quality grading were undertaken by two reviewers. Only trials with a randomised design comparing AGU care and conventional care units were included. Meta-analyses were performed in Review Manager 5.4 and the Grading of Recommendations, Assessment, Development and Evaluations framework was used to assess the certainty of evidence. The primary outcome was incidence of functional decline between baseline 2-week prehospital admission status and discharge and at follow-up. Results 11 trials recruiting 7,496 participants across three countries were included. AGU care resulted in a reduction in functional decline at 6-month follow-up (risk ratio (RR) 0.79, 95% confidence interval (CI) 0.66–0.93; moderate certainty evidence) and an increased probability of living at home at 3-month follow-up (RR 1.06, 95% CI 0.99–1.13; high certainty evidence). AGU care resulted in little or no difference in functional decline at hospital discharge or at 3-month follow-up, length of hospital stay, costs, the probability of living at home at discharge, mortality, hospital readmission, cognitive function or patient satisfaction. Conclusions AGU care improves clinical and process outcomes for hospitalised older adults with acute medical complaints. Future research should focus on greater inclusion of clinical and patient reported outcome measures.
Collapse
Affiliation(s)
- Íde O’Shaughnessy
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Margaret O’Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Mairéad Conneely
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Damien Ryan
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland
| | - Fiona Steed
- Medicine Directorate, University Hospital Limerick, Limerick, Ireland
| | - Leonora Carey
- Department of Occupational Therapy, University Hospital Limerick, Limerick, Ireland
| | - Aoife Leahy
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Elaine Shanahan
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Colin Quinn
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| |
Collapse
|
11
|
O’Connor M, Glenn A, Elissa C. 746 VALIDITY OF THE CARER DIRECTED NEEDS ASSESSMENT IN DEMENTIA (CANDID) FOR USE IN ADVANCED STAGE DEMENTIA CARE. Age Ageing 2022. [DOI: 10.1093/ageing/afac037.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
End of life care for people dying of dementia and their carer/s is a growing area of importance. Unmet needs are coming amongst this group. A tool to identify the needs of this person-carer dyad is a necessary component for providing this care. The aim of this project was to determine the validity of a new tool, the CArer directed NeeDs assessment In Dementia (CANDID), which was developed for use in a randomised trial of end of life dementia care.
Method
Face validity of CANDID was assessed by an expert panel. A narrative review of the literature to evaluate existing tools available for assessing the needs of carers of people with advanced stage dementia was conducted. A sample of ten trial participants independently completed CANDID and the Carer Specific Needs Assessment Tool (CSNAT), which was selected as the reference tool based on the narrative review. The results from CANDID and CSNAT were compared to assess criterion validity. Participants also completed an evaluation survey to determine which tool they preferred, and why. Responses were compared qualitatively and quantitatively.
Results
CANDID has good face validity. There were insufficient participant numbers to establish criterion validity. The majority (n = 8) of participants preferred CANDID. Participants described a preference for a face to face tool with more specific questions.
Conclusion
Participant carers of people dying of dementia in this trial setting preferred a face to face evaluation of needs. Preliminary results from this study suggest that CANDID has face and content validity, and shows promise for criterion validity.
Collapse
Affiliation(s)
- M O’Connor
- Fiona Stanely Hospital, Perth, Western Australia
| | - A Glenn
- University of Western Australia, Perth, Western Australia
| | - C Elissa
- Sir Charles Gairdner Hospital, Perth, Western Australia
| |
Collapse
|
12
|
Hennessy M, Scally S, Hannan M, Jordan E, Calvert P, O’Connor M, Horgan A. Evaluation of Nutritional Status in an Irish Geriatric Oncology Clinic. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00416-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
13
|
Cassarino M, Robinson K, Trépel D, O’Shaughnessy Í, Smalle E, White S, Devlin C, Quinn R, Boland F, Ward ME, McNamara R, Steed F, O’Connor M, O’Regan A, McCarthy G, Ryan D, Galvin R. Impact of assessment and intervention by a health and social care professional team in the emergency department on the quality, safety, and clinical effectiveness of care for older adults: A randomised controlled trial. PLoS Med 2021; 18:e1003711. [PMID: 34319971 PMCID: PMC8318294 DOI: 10.1371/journal.pmed.1003711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 06/26/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Older adults frequently attend the emergency department (ED) and experience high rates of adverse events following ED presentation. This randomised controlled trial evaluated the impact of early assessment and intervention by a dedicated team of health and social care professionals (HSCPs) in the ED on the quality, safety, and clinical effectiveness of care of older adults in the ED. METHODS AND FINDINGS This single-site randomised controlled trial included a sample of 353 patients aged ≥65 years (mean age = 79.6, SD = 7.01; 59.2% female) who presented with lower urgency complaints to the ED a university hospital in the Mid-West region of Ireland, during HSCP operational hours. The intervention consisted of early assessment and intervention carried out by a HSCP team comprising a senior medical social worker, senior occupational therapist, and senior physiotherapist. The primary outcome was ED length of stay. Secondary outcomes included rates of hospital admissions from the ED; hospital length of stay for admitted patients; patient satisfaction with index visit; ED revisits, mortality, nursing home admission, and unscheduled hospital admission at 30-day and 6-month follow-up; and patient functional status and quality of life (at index visit and follow-up). Demographic information included the patient's gender, age, marital status, residential status, mode of arrival to the ED, source of referral, index complaint, triage category, falls, and hospitalisation history. Participants in the intervention group (n = 176) experienced a significantly shorter ED stay than the control group (n = 177) (6.4 versus 12.1 median hours, p < 0.001). Other significant differences (intervention versus control) included lower rates of hospital admissions from the ED (19.3% versus 55.9%, p < 0.001), higher levels of satisfaction with the ED visit (p = 0.008), better function at 30-day (p = 0.01) and 6-month follow-up (p = 0.03), better mobility (p = 0.02 at 30 days), and better self-care (p = 0.03 at 30 days; p = 0.009 at 6 months). No differences at follow-up were observed in terms of ED re-presentation or hospital admission. Study limitations include the inability to blind patients or ED staff to allocation due to the nature of the intervention, and a focus on early assessment and intervention in the ED rather than care integration following discharge. CONCLUSIONS Early assessment and intervention by a dedicated ED-based HSCP team reduced ED length of stay and the risk of hospital admissions among older adults, as well as improving patient satisfaction. Our findings support the effectiveness of an interdisciplinary model of care for key ED outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT03739515; registered on 12 November 2018.
Collapse
Affiliation(s)
- Marica Cassarino
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, Ageing Research Centre, University of Limerick, Castletroy, Ireland
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, Ageing Research Centre, University of Limerick, Castletroy, Ireland
| | - Dominic Trépel
- Trinity Institute of Neurosciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Íde O’Shaughnessy
- Emergency Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Eimear Smalle
- Emergency Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Stephen White
- Emergency Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Collette Devlin
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, Ageing Research Centre, University of Limerick, Castletroy, Ireland
| | - Rosie Quinn
- Emergency Department, Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - Fiona Boland
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marie E. Ward
- School of Psychology, Trinity College, the University of Dublin, Dublin, Ireland
| | - Rosa McNamara
- Emergency Department, St. Vincent University Hospital, Dublin, Ireland
| | - Fiona Steed
- Department of Physiotherapy, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Margaret O’Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Castletroy, Ireland
| | - Andrew O’Regan
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Castletroy, Ireland
| | - Gerard McCarthy
- Emergency Department, Cork University Hospital, Cork, Ireland
| | - Damien Ryan
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, Ageing Research Centre, University of Limerick, Castletroy, Ireland
- * E-mail:
| |
Collapse
|
14
|
Affiliation(s)
- Meg Moorhouse
- Clinical Lead Bereavement Team, Melbourne City Mission Palliative Care, 472 Nicholson St, North Fitzroy, Melbourne 3168, Australia
| | - Margaret O’Connor
- Monash University, Melbourne, Research Consultant, Melbourne City Mission Palliative Care, 472 Nicholson St, North Fitzroy, Melbourne 3168, Australia
| |
Collapse
|
15
|
Affiliation(s)
- Margaret O’Connor
- Monash University, Peninsula Campus, Melbourne, Victoria, Australia
- Melbourne City Mission Palliative Care, Victoria, Australia
| |
Collapse
|
16
|
O’Connor M, Meageen S. Palliative care for asylum seekers living in the community in Australia. Progress in Palliative Care 2020. [DOI: 10.1080/09699260.2020.1810936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Margaret O’Connor
- Nursing & Midwifery, Monash University, PO Box 627, Frankston, VIC 3199, Australia
- Melbourne City Mission Palliative Care, 427 Nicholson St, North Fitzroy, VIC 3068, Australia
| | - Sarah Meageen
- Melbourne City Mission Palliative Care, 427 Nicholson St, North Fitzroy, VIC 3068, Australia
| |
Collapse
|
17
|
Stapleton A, O’Connor M, Feerick E, Kerr J, McHugh L. Testing the relationship between health values consistent living and health-related behavior. Journal of Contextual Behavioral Science 2020. [DOI: 10.1016/j.jcbs.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
18
|
Shah S, O’Connor M, Lewis C, Stephens J, Vaughan D, Chaggar R. Face-to-face videolaryngoscopy-assisted tracheal intubation: does the hand matter? Br J Anaesth 2020. [DOI: 10.1016/j.bja.2020.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
19
|
Aregay A, O’Connor M, Stow J, Ayers N, Lee S. Strategies used to establish palliative care in rural low- and middle-income countries: an integrative review. Health Policy Plan 2020; 35:1110-1129. [DOI: 10.1093/heapol/czaa051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 12/31/2022] Open
Abstract
Abstract
Globally, 40 million people need palliative care; about 69% are people over 60 years of age. The highest proportion (78%) of adults are from low- and middle-income countries (LMICs), where palliative care still developing and is primarily limited to urban areas. This integrative review describes strategies used by LMICs to establish palliative care in rural areas. A rigorous integrative review methodology was utilized using four electronic databases (Ovid MEDLINE, Ovid Emcare, Embase classic+Embase and CINAHL). The search terms were: ‘palliative care’, ‘hospice care’, ‘end of life care’, ‘home-based care’, ‘volunteer’, ‘rural’, ‘regional’, ‘remote’ and ‘developing countries’ identified by the United Nations (UN) as ‘Africa’, ‘Sub-Saharan Africa’, ‘low-income’ and ‘middle- income countries’. Thirty papers published in English from 1990 to 2019 were included. Papers were appraised for quality and extracted data subjected to analysis using a public health model (policy, drug availability, education and implementation) as a framework to describe strategies for establishing palliative care in rural areas. The methodological quality of the reviewed papers was low, with 7 of the 30 being simple programme descriptions. Despite the inclusion of palliative care in national health policy in some countries, implementation in the community was often reliant on advocacy and financial support from non-government organizations. Networking to coordinate care and medication availability near-patient homes were essential features of implementation. Training, role play, education and mentorship were strategies used to support health providers and volunteers. Home- and community-based palliative care services for rural LMICs communities may best be delivered using a networked service among health professionals, community volunteers, religious leaders and technology.
Collapse
Affiliation(s)
- Atsede Aregay
- Nursing and Midwifery, Monash University, Moorooduc Hwy, Frankston VIC 3199, Melbourne, Australia
| | - Margaret O’Connor
- Nursing and Midwifery, Monash University, Moorooduc Hwy, Frankston VIC 3199, Melbourne, Australia
- Melbourne City Mission Palliative Care
| | - Jill Stow
- St Vincent’s Private Hospital, Melbourne, Australia
| | - Nicola Ayers
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Susan Lee
- Nursing and Midwifery, Monash University, Moorooduc Hwy, Frankston VIC 3199, Melbourne, Australia
| |
Collapse
|
20
|
Meagher DJ, O’Connell H, Leonard M, Williams O, Awan F, Exton C, Tenorio M, O’Connor M, Dunne CP, Cullen W, McFarland J, Adamis D. Comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients. World J Psychiatry 2020; 10:46-58. [PMID: 32399398 PMCID: PMC7203081 DOI: 10.5498/wjp.v10.i4.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/17/2020] [Accepted: 03/04/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Efficient detection of delirium and comorbid delirium-dementia is a key diagnostic challenge. Development of new, efficient delirium-focused methods of cognitive assessment is a key challenge for improved detection of neurocognitive disorders in everyday clinical practice. AIM To compare the accuracy of two novel bedside tests of attention, vigilance and visuospatial function with conventional bedside cognitive tests in identifying delirium in older hospitalized patients. METHODS 180 consecutive elderly medical inpatients (mean age 79.6 ± 7.2; 51% female) referred to a psychiatry for later life consultation-liaison service with delirium, dementia, comorbid delirium-dementia and cognitively intact controls. Participants were assessed cross-sectionally with conventional bedside cognitive tests [WORLD, Months Backward test (MBT), Spatial span, Vigilance A and B, Clock Drawing test and Interlocking Pentagons test] and two novel cognitive tests [Lighthouse test, Letter and Shape Drawing test (LSD)-4]. RESULTS Neurocognitive diagnoses were delirium (n = 44), dementia (n = 30), comorbid delirium-dementia (n = 60) and no neurocognitive disorder (n = 46). All conventional tests had sensitivity of > 70% for delirium, with best overall accuracy for the Vigilance-B (78.3%), Vigilance-A (77.8%) and MBT (76.7%) tests. The sustained attention component of the Lighthouse test was the most distinguishing of delirium (sensitivity 84.6%; overall accuracy 75.6%). The LSD-4 had sensitivity of 74.0% and overall accuracy 74.4% for delirium identification. Combining tests allowed for enhanced sensitivity (> 90%) and overall accuracy (≥ 75%) with the highest overall accuracy for the combination of MBT-Vigilance A and the combined Vigilance A and B tests (both 78.3%). When analyses were repeated for those with dementia, there were similar findings with the MBT-Vigilance A the most accurate overall combination (80.0%). Combining the Lighthouse-SA with the LSD-4, a fail in either test had sensitivity for delirium of 91.4 with overall accuracy of 74.4%. CONCLUSION Bedside tests of attention, vigilance and visuospatial ability can help to distinguish neurocognitive disorders, including delirium, from other presentations. The Lighthouse test and the LSD-4 are novel tests with high accuracy for detecting delirium.
Collapse
Affiliation(s)
- David J Meagher
- Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Limerick V94 YVHO, Ireland
| | - Henry O’Connell
- Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Limerick V94 YVHO, Ireland
| | - Maeve Leonard
- Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Limerick V94 YVHO, Ireland
| | - Olugbenga Williams
- Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Limerick V94 YVHO, Ireland
| | - Fahad Awan
- Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Limerick V94 YVHO, Ireland
| | - Chris Exton
- Department of Computer Sciences, University of Limerick, Limerick V94 YVHO, Ireland
| | - Michael Tenorio
- Department of Computer Sciences, University of Limerick, Limerick V94 YVHO, Ireland
| | - Margaret O’Connor
- Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Limerick V94 YVHO, Ireland
| | - Colum P Dunne
- Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Limerick V94 YVHO, Ireland
| | - Walter Cullen
- Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Limerick V94 YVHO, Ireland
- School of Medicine, University College Dublin, Dublin 4 D04 V1W8, Ireland
| | - John McFarland
- Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Limerick V94 YVHO, Ireland
| | - Dimitrios Adamis
- Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Limerick V94 YVHO, Ireland
- Sligo Mental Health Services, Ballytivan, Sligo F91 CD34, Ireland
| |
Collapse
|
21
|
Cafferkey J, O’Connor M, Doyle D, Skally M, Fitzpatrick M, Burns K, O’Connell K, Fitzpatrick F, Smyth E, Humphreys H. Improving the processing time for the detection of carbapenemase-producing enterobacterales using an evolving algorithm. Br J Biomed Sci 2020; 77:97-100. [DOI: 10.1080/09674845.2019.1704357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- J Cafferkey
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - M O’Connor
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - D Doyle
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - M Skally
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - M Fitzpatrick
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - K Burns
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
- Health Protection Surveillance Centre, Dublin, Ireland
| | - K O’Connell
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - F Fitzpatrick
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - E Smyth
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - H Humphreys
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| |
Collapse
|
22
|
Dooley L, O’Reilly D, Prior L, Calvert P, O’Connor M, Horgan A, Jordan E. Obesity and cardiovascular risk in metastatic lung cancer patients. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30215-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
23
|
Dross S, Peterson C, O’Connor M, Tunggal H, Li J, Jerome K, Kiem H, Felber B, Mullins J, Fuller D. HIV persistence despite reservoir decay during combinatorial immunotherapy including therapeutic conserved elements (CE) DNA vaccination, αPD-1 therapy, GS-986 TLR7-agonism, and CCR5 gene-edited CD4 T cell infusion in rhesus macaques. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30204-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
24
|
Buck E, O’Connor M, Flohr A, Iacone R, Nicolaides T, Zhang J, Mayweg A, Epstein D. Oncogenic mutations at the dimer interface of EGFR lead to formation of covalent homo-dimers and allosteric activation of the kinase domain: A mechanism which alters the selectivity profile of oncogenic EGFR. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz244.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
25
|
Geoghegan AR, Walsh O, O’Connor M, Goode M, McDonagh S, Rochford A, Gavin P, Butler K. Benefit of Sequential Audit Cycles in Improving Management of Vitamin D Deficiency in the HIV Infected Paediatric Population. Ir Med J 2019; 112:990. [PMID: 31650823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Aims Lifelong HIV infection has an unknown impact on bone health in children. In view of this, we aimed to improve management of vitamin D deficiency. Methods Three audits over 8 years (2009-2017) were performed with interventions introduced intermittently in an effort to improve vitamin D deficiency. The interventions included education, a change in vitamin D dose and brand to increase compliance and a shift to nursing led management. Results The most striking result was the eradication of patients with deficient vitamin D levels (<25nmol/L) in 2017. In 2009 and 2015, 15% and 9% were deficient. In the earlier two studies, only 15% had ‘sufficient’ (>50nmol) vitamin D levels. This increased to 71% in 2017. 10% of patients had levels greater than >120nmol/L, increasing risk of vitamin D toxicity. 67% of patients with insufficient vit D (25-50nmol/L) were prescribed a stat high dose vitamin D (120,000 IU) to help avoid adherence issues. Conclusions Sequential audits along with a shift to nurse led management were the most likely reasons for sustained improvement. Similar projects in all medical departments could improve clinical outcomes.
Collapse
Affiliation(s)
- A R Geoghegan
- Paediatric Infectious Diseases Department, Our Lady’s Children’s Hospital, Crumlin
| | - O Walsh
- Children’s University Hospital, Temple St Dublin, Ireland
| | - M O’Connor
- Paediatric Infectious Diseases Department, Our Lady’s Children’s Hospital, Crumlin
| | - M Goode
- Paediatric Infectious Diseases Department, Our Lady’s Children’s Hospital, Crumlin
| | - S McDonagh
- Paediatric Infectious Diseases Department, Our Lady’s Children’s Hospital, Crumlin
| | - A Rochford
- Paediatric Infectious Diseases Department, Our Lady’s Children’s Hospital, Crumlin
| | - P Gavin
- Paediatric Infectious Diseases Department, Our Lady’s Children’s Hospital, Crumlin
- Children’s University Hospital, Temple St Dublin, Ireland
| | - K Butler
- Paediatric Infectious Diseases Department, Our Lady’s Children’s Hospital, Crumlin
- Children’s University Hospital, Temple St Dublin, Ireland
| |
Collapse
|
26
|
Barrett K, O’Connor M, McHugh L. A Systematic Review of Values-Based Psychometric Tools Within Acceptance and Commitment Therapy (ACT). Psychol Rec 2019. [DOI: 10.1007/s40732-019-00352-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
27
|
Cassarino M, Robinson K, Quinn R, Naddy B, O’Regan A, Ryan D, Boland F, Ward ME, McNamara R, O’Connor M, McCarthy G, Galvin R. Impact of early assessment and intervention by teams involving health and social care professionals in the emergency department: A systematic review. PLoS One 2019; 14:e0220709. [PMID: 31365575 PMCID: PMC6668840 DOI: 10.1371/journal.pone.0220709] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 07/22/2019] [Indexed: 11/19/2022] Open
Abstract
Background Dedicated Health and Social Care Professional (HSCP) teams have been proposed for emergency departments (EDs) in an effort to improve patient and process outcomes. This systematic review synthesises the totality of evidence relating to the impact of early assessment and intervention by HSCP teams on quality, safety and effectiveness of care in the ED. Methods A systematic literature search was conducted in April 2019 to identify experimental studies examining the effectiveness of ED-based HSCP teams providing services to adults aged ≥ 18 years old and including two or more of the following disciplines: occupational therapist, physiotherapist, medical social worker, clinical pharmacist, or speech and language therapist. Data extraction and quality appraisal of each study were conducted independently by two reviewers. Results Six studies were included in the review (n = 273,886), all describing interdisciplinary Care Coordination Teams (CCTs) caring for adults aged ≥ 65 years old. CCT care was associated with on average 2% reduced rates of hospital admissions (three studies), improved referrals to community services for falls (one study), increased satisfaction (two studies) with the safety of discharge (patients and staff), and with the distribution of workload (staff), improved health-related quality of care (one study). No statistically significant differences between intervention and control groups emerged in terms of rates of ED re-visits, ranging between 0.2% and 3% (two studies); hospital length of stay (one hour difference noted in one study) or mortality rates (0.5% difference in one study). Increased rates of unplanned hospitalisations following the intervention (13.9% difference) were reported in one study. The methodological quality of the studies was mixed. Discussion We found limited and heterogeneous evidence on the impact of HSCP teams in the ED, suggesting a reduction in hospital admissions as well as improved patient and staff satisfaction. More robust investigations including cost-effectiveness evaluations are needed.
Collapse
Affiliation(s)
- Marica Cassarino
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, Ageing Research Cluster, University of Limerick, Limerick, Ireland
- * E-mail:
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, Ageing Research Cluster, University of Limerick, Limerick, Ireland
| | - Rosie Quinn
- Emergency Department, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Breda Naddy
- Clinical Strategy and Programmes Division, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Andrew O’Regan
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Damien Ryan
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Retrieval, Emergency and Disaster Medicine Research and Development Unit (REDSPoT), Emergency Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Fiona Boland
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marie E. Ward
- School of Psychology, Trinity College, the University of Dublin, Dublin, Ireland
| | - Rosa McNamara
- Emergency Department, St. Vincent’s University Hospital, Dublin, Ireland
| | - Margaret O’Connor
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Gerard McCarthy
- Emergency Department, Cork University Hospital, Cork, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, Ageing Research Cluster, University of Limerick, Limerick, Ireland
| |
Collapse
|
28
|
Kelly D, O’Connor M. Challenges of Cancer Screening. Ir Med J 2019; 112:945. [PMID: 31535834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- D Kelly
- Department of Medical Oncology, University Hospital Waterford
| | - M O’Connor
- Department of Medical Oncology, University Hospital Waterford
| |
Collapse
|
29
|
O’Connor M, Tennyson A, Timmons M, McHugh L. The development and preliminary psychometric properties of the Values Wheel. Journal of Contextual Behavioral Science 2019. [DOI: 10.1016/j.jcbs.2019.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
30
|
D’Alton M, Malomo K, Beirne A, Uidhir FM, Short E, O’Connor M, Dolan E. 44THE PATIENT EXPERIENCE OF HOME CARE SERVICES. Age Ageing 2019. [DOI: 10.1093/ageing/afy211.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M D’Alton
- Department of Medicine for the Elderly, Connolly Hospital Blanchardstown, Dublin
| | - K Malomo
- Department of Medicine for the Elderly, Connolly Hospital Blanchardstown, Dublin
| | - A Beirne
- Department of Medicine for the Elderly, Connolly Hospital Blanchardstown, Dublin
| | - F M Uidhir
- Department of Medicine for the Elderly, Connolly Hospital Blanchardstown, Dublin
| | - E Short
- Department of Medicine for the Elderly, Connolly Hospital Blanchardstown, Dublin
| | - M O’Connor
- Department of Medicine for the Elderly, Connolly Hospital Blanchardstown, Dublin
| | - E Dolan
- Department of Medicine for the Elderly, Connolly Hospital Blanchardstown, Dublin
| |
Collapse
|
31
|
Shanahan E, Carew S, Costelloe A, Sheehy T, Kiernan T, Peters C, Lyons D, O’Connor M. 108ABNORMAL DIURNAL BLOOD PRESSURE VARIABILITY IN PATIENTS WITH RECENT DELIRIUM. Age Ageing 2019. [DOI: 10.1093/ageing/afy204.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Shanahan
- University Hospital Limerick
- University of Limerick
| | - S Carew
- University Hospital Limerick
| | | | | | - T Kiernan
- University Hospital Limerick
- University of Limerick
| | | | - D Lyons
- University Hospital Limerick
- University of Limerick
| | - M O’Connor
- University Hospital Limerick
- University of Limerick
| |
Collapse
|
32
|
McKenna L, Wood P, Williams A, O’Connor M, Moss C, Griffiths D, Della P, Endacott R, Cross W. Scope of practice and workforce issues confronting Australian Enrolled Nurses: A qualitative analysis. Collegian 2019. [DOI: 10.1016/j.colegn.2018.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
33
|
O’Connor M, Carleton O, Larsen P, Hooks D. Does Lead Abandonment Lead to Increased Risk of Long-Term Complications for Patients with CIEDs? Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
34
|
Gabr A, Keyes M, Thavarajah K, Dillon J, Cunningham N, O’Hara P, Zulkifli D, Gumani D, Murphy J, Canavan M, Costello M, Leahy A, McManus J, Lyons D, Peters C, Quinn C, Muthalvan N, ElKholy K, O’Connor M. 250Improving Care for Patients with Intracerebral Haemorrhage. Age Ageing 2018. [DOI: 10.1093/ageing/afy141.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Gabr
- University Hospital Limerick, Limerick, Ireland
| | - M Keyes
- University Hospital Limerick, Limerick, Ireland
| | | | - J Dillon
- University Hospital Limerick, Limerick, Ireland
| | | | - P O’Hara
- University Hospital Limerick, Limerick, Ireland
| | - D Zulkifli
- University Hospital Limerick, Limerick, Ireland
| | - D Gumani
- University Hospital Limerick, Limerick, Ireland
| | - J Murphy
- University Hospital Limerick, Limerick, Ireland
| | - M Canavan
- University Hospital Limerick, Limerick, Ireland
| | - M Costello
- University Hospital Limerick, Limerick, Ireland
| | - A Leahy
- University Hospital Limerick, Limerick, Ireland
| | - J McManus
- University Hospital Limerick, Limerick, Ireland
| | - D Lyons
- University Hospital Limerick, Limerick, Ireland
| | - C Peters
- University Hospital Limerick, Limerick, Ireland
| | - C Quinn
- University Hospital Limerick, Limerick, Ireland
| | - N Muthalvan
- University Hospital Limerick, Limerick, Ireland
| | - K ElKholy
- Tallaght University Hospital, Dublin, Ireland
| | - M O’Connor
- University of Limerick, Limerick, Ireland
| |
Collapse
|
35
|
Brennan M, O’Connor M, McManus J, Moloney T, Cunningham N. 41Getting the Right Flow: Quality Improvement Project of Carotid Doppler Ultrasound Service in Acute Stroke Patients at University Hospital Limerick. Age Ageing 2018. [DOI: 10.1093/ageing/afy140.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
36
|
Thavarajah K, Gabr A, Quinn C, Lyons D, O’Connor M, Peters C, Musa M, Kavanagh E, Schnittger PT, Samaflava O, Monahan D, Muthalvan N, Costello M, Canavan M, Leahy A. 255Medication Errors- An Unidentified Silent Killer- Jack the Ripper of Our Age. Age Ageing 2018. [DOI: 10.1093/ageing/afy140.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Ahmed Gabr
- University Hospital Limerick, Limerick, Ireland
| | - Colin Quinn
- University Hospital Limerick, Limerick, Ireland
| | | | | | | | - Monzar Musa
- University Hospital Limerick, Limerick, Ireland
| | | | | | | | | | | | | | | | - Aoife Leahy
- University Hospital Limerick, Limerick, Ireland
| |
Collapse
|
37
|
Shanahan E, Ryan S, Costelloe A, Sheehy T, Peters C, Lyons D, O’Connor M. 115Reduced Baroreceptor Sensitivity in Patients with Recent Delirium. Age Ageing 2018. [DOI: 10.1093/ageing/afy140.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Elaine Shanahan
- University Hospital Limerick, Limerick, Ireland
- University of Limerick, Limerick, Ireland
| | - Sheila Ryan
- University Hospital Limerick, Limerick, Ireland
| | | | - Tina Sheehy
- University Hospital Limerick, Limerick, Ireland
| | | | | | | |
Collapse
|
38
|
Hynes J, Gumani D, Costello M, Quinn C, O’Connor M, Peters C, Lyons D. 223Lightning and Autonomic Failure; A Shocking Case Report of Postural Hypotension. Age Ageing 2018. [DOI: 10.1093/ageing/afy140.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jason Hynes
- University Hospital Limerick, Limerick, Ireland
| | | | | | - Colin Quinn
- University Hospital Limerick, Limerick, Ireland
| | | | | | | |
Collapse
|
39
|
Keyes M, Gabr A, Gumani D, Zulkfilki D, O’Connor M, Lyons D, Peters C, Quinn C, McManus J. 220A Service Development Pathway in Patients with Transient Ischaemic Attack. Age Ageing 2018. [DOI: 10.1093/ageing/afy140.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael Keyes
- Department of Aging and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Ahmed Gabr
- Department of Aging and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Dikshaini Gumani
- Department of Aging and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Danial Zulkfilki
- Department of Aging and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Margaret O’Connor
- Department of Aging and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Declan Lyons
- Department of Aging and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Catherine Peters
- Department of Aging and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Colin Quinn
- Department of Aging and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - John McManus
- Department of Aging and Therapeutics, University Hospital Limerick, Limerick, Ireland
| |
Collapse
|
40
|
Thavarajah K, Quinn C, Murphy S, Gabr A, Lyons D, O’Connor M, Peters C, Musa M, McKiernan C, Muthalvan N. 259Cerebral Amyloid Angiopathy - Related Inflammation: A Case Report. Age Ageing 2018. [DOI: 10.1093/ageing/afy140.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Colin Quinn
- University Hospital Limerick, Limerick, Ireland
| | - Sean Murphy
- Mater Misericordiae Hospital, Dublin, Ireland
| | - Ahmed Gabr
- University Hospital Limerick, Limerick, Ireland
| | | | | | | | - Monzar Musa
- University Hospital Limerick, Limerick, Ireland
| | | | | |
Collapse
|
41
|
Keyes M, Gabr A, Gumani D, Zulkifli D, O’Connor M, Lyons D, Peters C. 293An Observational Study of Relationship Between Body Mass Index and Bone Mass Density Over 15 Year Period. Age Ageing 2018. [DOI: 10.1093/ageing/afy140.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael Keyes
- Department of Aging and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Ahmed Gabr
- Department of Aging and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Dikshaini Gumani
- Department of Aging and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Danial Zulkifli
- Department of Aging and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Margaret O’Connor
- Department of Aging and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Declan Lyons
- Department of Aging and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Catherine Peters
- Department of Aging and Therapeutics, University Hospital Limerick, Limerick, Ireland
| |
Collapse
|
42
|
Indorewalla K, Sugarman M, Daley R, Clark E, Scoglio A, O’Connor M. A - 17The Aging Well Through Interaction and Scientific Education (AgeWISE) Program: Examining Changes in Attitudes Toward Cognitive Aging in Older Veterans at Six-Month Follow-Up. Arch Clin Neuropsychol 2018. [DOI: 10.1093/arclin/acy061.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
43
|
Rosenberg JP, O’Connor M, Huang X. A qualitative evaluation of Australian palliative care services’ participation in National Palliative Care Standards self-assessment. Progress in Palliative Care 2018. [DOI: 10.1080/09699260.2018.1454093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- John P. Rosenberg
- Institute of Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | | | - Xiaoyan Huang
- School of Nursing & Midwifery, Fudan University, Shanghai, People’s Republic of China
| |
Collapse
|
44
|
O’Connor M, Harding S, Kirby A, Wilkins B, Larsen P. Current Anticoagulant and Antiplatelet Prescribing Practice in Acute Coronary Syndromes With Concurrent Atrial Fibrillation Across Australia And New Zealand. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
45
|
O’Connor M, Hooks D, Webber M, Shi B, Morrison S, Harding S, Larsen P. Long-Term Single-Centre Comparison of Implantable Cardioverter-Defibrillator Lead Survival: Evidence for Premature Linox Lead Failure. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
46
|
Rodriguez J, Huerta-Leidenz N, Murillo O, O’Connor M, Rodas-Gonzalez AR. Characteristics of Beef Carcasses Derived from Costa Rican Cattle as Affected by Gender and Dentition Age. Meat and Muscle Biology 2018. [DOI: 10.22175/rmc2018.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
47
|
|
48
|
Shanahan E, Tariq S, Lyons D, O’Connor M, Peters C. 269What Happens to Our Oldest Old? A Review One Year Following Acute Hospital Discharge. Age Ageing 2017. [DOI: 10.1093/ageing/afx144.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
49
|
Moloney E, Beirne A, McGrath K, O’Connor M, Lyons D, Ryan C. 191Hypocalcaemia and Denosumab in the Treatment of Osteoporosis: A Prospective Study. Age Ageing 2017. [DOI: 10.1093/ageing/afx144.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
50
|
Keyes M, Lehane C, Corcoran A, Gabr A, O’Connor M, Moloney T, McManus J, Cunningham N, Lyons D, Peters C. 242Retrospective Audit of Delays in Carotid Doppler Services for TIA and Minor Stroke in Mid-Western Tertiary Hospitals. Age Ageing 2017. [DOI: 10.1093/ageing/afx144.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|